KIDS i t’s A h o s

KID
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Niswonger Children’s Hospital
Because children are growing and developing, children’s
health care needs are constantly changing. They need
health care that is tailored to their unique needs,
involves their parents from start to finish and is provided
in places designed to be kid-sized and child-friendly.
That’s why the children of Southern Appalachia need
Niswonger Children’s Hospital.
This hospital was designed to provide for the unique
needs of children and combines compassionate,
personalized care with state-of-the-art technology.
Niswonger Children’s Hospital is dedicated to ensuring
that every child has access to high-quality, cost-effective
health care services.
For more information about Niswonger Children’s
Hospital, call Joanna Swinehart at 423-431-1014
or e-mail [email protected]
5
A Note From Our CEO
Quality care and service excellence have been strong
themes throughout fiscal year 2012 at Niswonger
Children’s Hospital. In addition to focusing on
improving patient outcomes through evidenced-based
quality measures, this year we have placed a major
emphasis on hardwiring patient-centered processes
throughout the services provided at Niswonger
Children’s Hospital.
In addition to our Family Advisory Council meetings,
where we listen and respond to the suggestions
provided by current and former patient families,
Niswonger Children’s Hospital has established a
Service Excellence Committee, a multi-disciplinary
group of front-line and leadership team members who
meet monthly to analyze and respond to the feedback
we receive from patient surveys.
The challenges of providing pediatric care are neverceasing, as we face continual changes due to health
care reform and the on-going legislative decisions
that have the potential to greatly impact our ability to
offer the highest quality care for all children. We know
it is important to keep our mission on the forefront,
and to allow the voice of our patients, often the most
vulnerable, to be heard by policy and decision makers,
including our national and state legislators.
Steven Godbold, AVP/CEO
Niswonger Children’s Hospital
Our focus on improving health outcomes for the
children in our region extends beyond the physical
walls of the hospital. We commit resources to bringing
health education messages to children throughout the
community in a variety of settings, so that they will
never know the inside of a hospital room.
As I review the year 2012, I take great pride in the
accomplishments made by each department, unit,
physician and team member. More than that, I take
great pride in knowing that each team member at
Niswonger Children’s Hospital has made a positive
difference in the life and health of the children of
our region.
Sincerely,
7
A Note From Nursing Leadership
The past year has been exciting for the clinical team
at Niswonger Children’s Hospital due to several
successes in the areas of quality and patient care.
We implemented a new role of Pediatric Clinical
Coordinator in order to begin a more in-depth focus
on our patients diagnosed with pediatric asthma. The
registered nurse in this position has been working to
better coordinate care by rounding on patients in the
hospital, working with families at discharge, providing
education to school nurses and following up with
community pediatricians. Our goal is to ensure that
our patients with asthma receive seamless care that
is coordinated on the inpatient and outpatient level.
We also are sharing best practices with our partners
at Cincinnati Children’s Hospital and Medical Center
to ensure that we deliver the highest quality of care
backed by research.
Our multidisciplinary team in the NICU has developed
family meetings to better serve our long-term NICU
patients. We are working to again provide seamless
care and ensure that our families have the best
information about the plan of care for their child.
Keeping open communication has helped families
during a very difficult time.
Lisa Carter, RNC, MSN
Director of Patient Care Services
Niswonger Children’s Hospital
I am extremely proud to serve as the nursing
leader for Niswonger Children’s Hospital. Our team
continually strives to provide care that is tailored to
pediatric patients and families. It is my goal to make
sure that families recognize immediately how our
children’s hospital is different and why the care that
their child receives here is specifically designed for
individual needs and developmental stages. I look
forward to the future of children’s health care for our
region as we continue to grow services and expand
our coverage.
Sincerely,
9
A Note from the Chair, Department of Pediatrics
Quillen College of Medicine, East Tennessee State University
Thanks to ties with pediatric research at East
Tennessee State University’s Quillen College of
Medicine, and our affiliation with St. Jude’s
Children’s Research Hospital, sick children at
Niswonger Children’s Hospital have access to
experts around the world and can be sure of
getting the best care possible.
We can attribute a large part of growth in pediatric
services to the fully accredited pediatric resident
program at ETSU’s Quillen College of Medicine.
Since 1992, the collaborative residency program
has trained 85 pediatric physicians, 70 percent of
whom now practice pediatric primary care. To date,
about one-third of our resident graduates practice
pediatrics in the Tri-Cities and 60 percent have
remained in Tennessee. The impact of this residency
program to our area has been tremendous. At the
same time, the scope and size of the neonatal
intensive care at Niswonger Children’s Hospital has
more than tripled, pediatric critical care has been
expanded, additional pediatric subspecialists have
been recruited and MSHA has developed a dedicated
pediatric emergency room facility and staff.
David Kalwinsky, MD
Chairman, Department
of Pediatrics, Quillen College of
Medicine, East Tennessee
State University
Now each year, 18 pediatric resident physicians
spend their days at Niswonger Children’s Hospital,
serving children and their families and learning from
pediatric subspecialists. As Niswonger Children’s
Hospital continues to serve as a learning center
for these new pediatric doctors, we can count on
the fact that they are serving our community well
as they care for and help heal our children. Upon
completion of their training, they will become the
future physician leaders and health advocates for
children’s health care.
11
~5~
Pediatric Intensive Care
When Patient Care Requires Critical Attention
When you work in the Pediatric Intensive Care Unit (PICU), you never
know who you’re going to see. A seven year old with leukemia. A
teen victim of a traumatic car crash. A three year old with a brain
injury. Whatever their age or diagnosis, our young patients with
single and multi-organ system failure need care relating to their
age, size and understanding. The kind of care unique to a hospital
for children.
Our providers for these critically ill children at Niswonger Children’s
Hospital include those trained in subspecialties focused
on children and using cutting-edge therapies — pediatric
cardiology, pediatric pulmonary medicine, pediatric
C-DIFF
rehabilitation and more — something rare at traditional
Clostridium difficile
hospitals. Our nurses are trained in pediatric critical care.
(total number of infections)
Our PICU medical team holds multi-disciplinary rounds
daily to ensure that all the caregivers involved in a PICU
patient’s care can provide feedback on a child’s care and
help develop goals for discharge.
Intensive care patients often have weakened immune
systems which put them at risk for hospital acquired
infections. Children come to our hospital to get better,
not sicker. The PICU at Niswonger Children’s Hospital has worked
diligently to reduce, and in many cases, eliminate the risk of a
child contracting an infection in the hospital. With protocols in
place to prevent infection, the PICU reduced both rates of central
line-associated blood stream infections (CLABSI) and ventilatorassociated pneumonia (VAP) by 100 percent.
Melinda Lucas, MD
Pediatric Critical
Care Physician
NICU
&
PICU
0
VAP
Ventilator-associated pneumonia
(total number of infections)
NICU
&
PICU
0
13
neonatal intensive care
When Little Bodies Need Big Help
Our tiniest patients. Delicate, but little fighters, every
one. We’ve treated 480 infants in our level three
Neonatal Intensive Care Unit this past year. Families
comprising our NICU come from 18 counties in
four different states to receive care from the most
advanced NICU team in the region. It’s been a year
of growth in our services with new programs and
protocols that give each precious patient a better
chance of staying with us and with better outcomes.
Niswonger Children’s Hospital works closely with the
Tennessee Initiative for Perinatal Quality Care (TIPQC),
whose mission is to improve the health outcomes
for mothers and infants. One of the main projects for
2012 was to increase the consumption of human milk,
or breast-feeding. Why is breast-feeding important?
Besides the fact that human milk is the most perfectly
formulated food for newborns, human milk can
provide immunities to infections that a NICU infant’s
compromised immune system desperately needs.
With a very focused effort on promoting breastfeeding, the NICU medical team provided staff
education and then helped and encouraged new
moms to try breast-feeding, giving them support
when things got tough. The Niswonger NICU team
held monthly meetings with TIPQC to keep on track,
Mike DeVoe, MD
Medical Director
Neonatal Intensive
Care Unit
and found the results staggering. Breast-feeding rates
for NICU patients have increased from 32 percent
in 2010 to 65 percent in 2012, and those breastfeeding at discharge have increased from 27 to 46
percent for those same years.
Not only did the babies benefit from increased
human milk consumption, but NICU team members
recognized that NICU mothers benefited from the
opportunity of participating in their babies’ care by
providing breast milk, even when their babies were
too sick to be held.
Many of our Neonatal Intensive Care Unit team
members take their jobs beyond what’s required as
volunteers with March of Dimes, the state regional
health council and Child Fatality Review Committee.
We give beyond the hours we have to because these
high-risk newborns touch our hearts. We want theirs
to touch the future.
15
st. jude tri-citites affiliate clinic
Keeping Kids at Home
“Cancer” is a word that no parent wants to hear.
Fortunately, children at Niswonger Children’s Hospital
have had access to the leader in pediatric cancer
research through an affiliation with St. Jude Children’s
Research Hospital since 1998. The St. Jude Tri-Cities
Affiliate Clinic has continued in its effort of improving
pediatric oncology and hematology care throughout the
year. The physicians on staff at the local affiliate have
contributed to the research effort by submitting their
research which has been published by the American
Academy of Pediatrics.
The patients receiving pediatric hematology and
oncology care through the St. Jude Tri-Cities Affiliate are
able to receive most of their treatment on an outpatient
basis. This past year the St. Jude Tri-Cities Affiliate
provided more than 3,000 patient visits in its outpatient
clinic. Providing care on an outpatient basis allows
patients to be at home with their families and among all
the other comforts of home. Over the last several years,
the St. Jude Tri-Cities Affiliate has been successful at
reducing the number of days that its pediatric patients
have had to spend in the hospital. This helps reduce
medical costs by providing care in a lower acuity setting,
and most importantly, it means that more patients were
able to be at home instead of in the hospital.
Kathy Klopfenstein, MD
Medical Director
St. Jude Tri-Cities
Affiliate Clinic
St. Jude Tri-Cities Affiliate Clinic
Inpatient Days FY 2005 – 2012
2012
2011
2010
2009
2008
2007
2006
2005
720
1,266
1,805
1,717
2,002
2,221
2,000
1,791
17
niswonger children’s emergency
Improving the Quality of Pediatric Emergency Medicine
Not all emergency medicine practiced at Niswonger
Children’s Hospital occurs in the Children’s Emergency
department. Leadership of Niswonger Children’s
Emergency has recognized trends in treatment for
certain conditions, such as asthma and appendicitislike symptoms, and has worked to share best
practice education for pediatric care throughout
the community.
Current research shows that children exposed to
radiation are eight times more likely to develop
cancer than adults with the same exposure.
To reduce unecessary exposure, the Children’s
Emergency medical team has put protocols in place
requiring diagnostic methods other than CT scans
for children who present with appendicitis-like
symptoms. Because so many children are treated
at other community EDs before being transferred
to Niswonger, we have reached out to community
hospitals to share this new preferred protocol.
We also have worked within the network of primary
care offices, emergency departments and hospitals
throughout the region to share education regarding
our Asthma Care Model, a plan which helps monitor
pediatric asthma patients and will reduce the number
of ED visits for children with asthma. Throughout
2012, we were able to reach 95 percent compliance in
asthma performance improvement monitoring.
Sandra Castro, MD
Medical Director
Children’s Emergency
Department
As a part of our community service efforts, the
physicians from Niswonger Children’s Emergency,
Pediatric Intensive Care Unit and pediatric surgery
collaborated for the first annual Pediatric Emergency
Medical Services Seminar. Niswonger is the only
pediatric-specific emergency department in the
region offering 24-hour emergency care by personnel
specifically trained to care for patients from birth to
18 years old; we’re happy to share what we know.
With almost 13,000 children treated in the ED this
year, we’ve added two more pediatric emergency
medicine physicians for a total of four. When a child
has an emergency, this is the place to be — with
a medical team and equipment designed just for
them. But it’s satisfying to know that thanks to our
community outreach, we’ve had a hand in preventing
some of them from being here in the first place.
19
THE BERRY FAMILY
A Micro-Preemie Miracle Story
This could not be happening, thought Betsy Berry, a
mother-to-be in her second trimester. The baby wasn’t
due for months! She and her husband, Scott, lived in
Virginia Beach, Va., and were in Johnson City, Tenn.,
working on assignment for Chick-fil-A, Scott’s employer.
The pains, though, assured her that the premature labor
was very real.
The neonatal team suggested that the couple be
prepared to relish the time with their baby for
however long he lived after birth. The neonatologists
at Niswonger had shared with the couple the risks
associated with premature birth. Despite the odds,
Betsy and Scott asked the neonatal intensive care team
to do all they could to save Judah’s life.
Betsy hadn’t scoped out facilities in the area for delivery
or infant care in the Tri-Cities, but she remembered
seeing a sign for Niswonger Children’s Hospital on her
way to the grocery store one day. Recognizing that a
children’s hospital would be the best place for their son,
the Berry couple headed to Johnson City Medical Center
next to Niswonger.
The Niswonger Children’s Hospital neonatal team
switched into high gear, but the next 140 days were
difficult. Through triumphs and setbacks, there was
always hope and encouragement from the NICU team
working to send Judah home healthy.
Even after going to great lengths to slow down Betsy’s
labor, baby Judah was born at 23-weeks gestation. He
was what NICU medical teams call a “micro-preemie.”
With neonatal viability defined at 24 weeks, many
babies born even after this time don’t survive, or, they
often face lifelong health complications. Many
live only a few minutes.
Scott, Betsy
and Judah Berry
In July, 2012, more than four months after his
birth, Judah was discharged. While he still requires
supplemental oxygen, he is growing and developing
normally. Scott and Betsy still haven’t moved back to
Virginia Beach. Now expecting their second child, the
Berry family doesn’t want to be anywhere else. This
time, Betsy’s fears are eased knowing that the healing
hands of the neonatal intensive care team at Niswonger
Children’s Hospital will be ready and waiting, if needed.
21
child life services
Celebrating a Child’s Life, Every Day
Being sick or hurt can be scary, especially for kids.
Children who find themselves in a strange place like a
hospital often experience fear and anxiety. That’s where
Child Life Services comes in. Child Life is an integral part
of any children’s hospital, and Niswonger Children’s
Hospital is no exception.
Child Life specialists use play, education and
support to help make the hospital experience
as comfortable and normal as it can be for
the patients in Niswonger Children’s Hospital.
With teaching tools such as special dolls and
medical equipment, they explain treatments
and procedures. They help children develop
coping strategies and promote family
involvement, including sibling visits.
Celebrating milestones and special
events are important in every child’s life.
This is why Child Life coordinates holiday
events and birthday parties for families
who find themselves in the hospital during
those special times of the year.
590 hrs.
$12,856.10
15,307 hrs.
$333,539.53
GIFT SHOP
160 hrs.
$3,486.40
PATIENT
AMBASSADOR
2,014 hrs.
$43,885.06
INFORMATION DESK
300 hrs.
$6,537.00
CUDDLER PROGRAM
9,531 hrs.
$207,680.49
HOME WORKERS
At Niswonger Children’s Hospital, the Child Life
specialists are an integral part of the health care team
designed to help children and their families cope with
illness, hospitalization and separation from home, school,
routine and friends. Their work ensures that each child’s
developmental, emotional and psychosocial needs are
met while they’re here, so that their stay at Niswonger
Children’s Hospital can be as positive as possible.
Erin Baccus,CCLS
Child Life Specialist
Total Volunteer
Hours FY12
2,402 hrs.
$52,339.58
CHILD LIFE
310 hrs.
$6,754.90
PET THERAPY
23
asthma care
Creating Care Models, Improving Outcomes
About 10 percent of all children in the U.S. suffer from
asthma, a long-term respiratory condition that can be
fatal. Still, children with asthma can lead normal lives
with proper monitoring and medication. That requires a
collaborative effort of primary care providers, specialists
and hospital physicians all treating patients according to
current research and best practice.
This year, Niswonger Children’s Hospital Asthma Care
Model Team spearheaded an effort to create seamless
pediatric asthma care within the network of primary
care offices, emergency departments and hospitals in
the community. Families, teachers and primary care
providers provided input resulting in 1) care maps with
detailed steps for caring for patients in the doctor’s
office, the emergency department and inpatient settings;
2) evidence-based care guidelines for EDs; 3) a summary
of current research and evidence for outpatient care
recommendations; and 4) creation of an asthma advisory
committee composed of health care providers from
primary care, emergency deparments and inpatient
care settings.
Working collaboratively within the communities it serves,
Niswonger Children’s Hospital is reducing the frequency
of asthma-related ED visits and hospital admissions
and, ultimately, improving the quality of life for children
with asthma.
Claire Marr, RN
Pediatric Clinical Coordinator
ASTHMA
DIAGNOSIS
JULY 2011 – JUNE 2012
333
EMERGENCY ROOM
103
81
OUTPATIENT
INPATIENT
TOTAL DIAGNOSES
517
25
the get well network
Improving the Hospital Experience
What do new-release movies, video games, Internet
access and streaming music on Niswonger Children’s
Hospital’s interactive Get Well Network have to do
with getting well? For children confined to a children’s
hospital it can mean a welcome distraction from
the reason they are there. For patient families it
means instant communication with the nursing
leadership and access to interactive information
and education tailored to the health needs of their
child. For the hospital it can mean better patient
outcomes, higher patient satisfaction and improved
hospital performance.
Niswonger Children’s Hospital’s leadership recognized
the need to include state-of-the art technology
as an integral part of a personalized patient care
experience before the hospital was built. So, during
construction, patient care rooms were wired with the
plan to implement an interactive system. In December
2011, Niswonger Children’s Hospital began a massive
education process to train key team members to
be system managers and “super users,” and offered
training to all the Niswonger care team. Then, after
many years of planning and building excitement,
Niswonger’s Get Well Network went “live” for patient
use in May 2012.
Christy Tyree
Communications and
Get Well Network Associate
The Get Well Network has proven to be a win-winwin situation for patients, their families and the
hospital care team. Patients are happy — they love
the screen time for age-appropriate games, movies,
music and social networking. Patient families are
satisfied — they appreciate access to information
tailored to their child’s diagnosis and the instant
communication with nursing leadership, which allows
the nursing team to make immediate changes to
improve a patient experience. Hospital performance
has improved — active engagement with patients
and families helps the nursing team respond more
quickly and appropriately to patient needs and to
recognize team members for a job well done. With
the Get Well Network, the patient’s health care
journey has become a time of engagement, education,
communication and even a little fun, leading to a
better experience for everyone involved.
27
family advisory council
Improving Family-Centered Care
Who better to think of ways to help the hospital
improve the way it relates to patients and their
families than the very ones who spend so much
time there? That’s why members of the Niswonger
Children’s Hospital Family Advisory Council (FAC) are
family members of current and former patients. The
group meets regularly with one goal in mind — to
discover areas where the hospital can improve by
focusing on family-centered care.
One resounding suggestion made by the group was
the need for more engagement between the patient’s
family and the medical team during the development
of the patient’s care plan during hospitalization. The
hospital leadership listened and began to work toward
a process for family-centered rounds.
Patient Rowan Parker, his mom
Sarah and members of
Rowan’s medical team
First, Niswonger engaged Cincinnati Children’s
Hospital, a renowned leader in the family-centered
care model, to provide training in implementing the
model at Niswonger. A focus group including hospital
administration, nursing and medical leadership, and
FAC representatives initiated a procedure that would
promote more patient family interaction with the
medical team during daily physician rounds.
Following the Mountain States Health Alliance quality
improvement model, Plan-Do-Check-Act (PDCA),
hospital leadership continues to hone a process for
family-centered rounds that meets the needs of the
entire medical care team, and most importantly, the
patients it serves.
29
legislative advocacy
Giving a Voice to Children’s Health Care
Big decisions about the future of health care are
being made at both state and federal levels. You see
it in the news every day. Unfortunately, the unique
health care needs of children — a very distinct and
disproportionate population in the health care world
— often are overshadowed by larger groups with more
lobbying power.
But at Niswonger Children’s Hospital, we know that
small bodies have strong voices. Long-time Niswonger
patient and cancer survivor Henry Hance may be
small in size, but his voice and message about the
importance of children’s hospitals has now been heard
loud and clear all over Washington, D.C.
In July 2011, Niswonger hosted Henry and his family
at the Speak Now for Kids Family Advocacy Day at the
nation’s capital. There Henry candidly relayed to United
States Senator Bob Corker and Congressman Phil Roe
why children’s hospitals are so important to kids like
him. His on-going needs still require hospitalization
from time to time, and Henry’s captivating smile and
strong voice reminded the legislators why it’s their job
to stand firm in support of children’s health care needs
when they are making tough decisions in Congress
… and why it’s important for them to realize that the
very lives of this special group lie not only with their
doctors, but with those who vote on Capitol Hill.
Henry Hance, Ambassador
Niswonger Children’s Hospital
NICU, PICU & PEDATRICS
Payor Mix FY12
TennCare
BlueCross BlueShield
Commercial
Medicaid
CHILDREN’S PEDIATRIC ED
John Deere
Self-pay
Other
Medicare
ST. JUDE TRI-CITIES
AFFILIATE CLINIC
31
social responsibility
Promoting Health Througout the Region
Patients come to Niswonger Children’s Hospital
knowing that they will experience exceptional
family-centered care during their visit. That same
family-centered care extends beyond the walls of
the hospital through key outreach programs that
provide awareness and health education to patients
and their families in communities throughout the
Northeast Tennessee and Southwest Virginia region.
Niswonger’s outreach programs target crucial health
issues, such as childhood obesity, that affect many
children in our region. In an effort to reduce the
impact of childhood obesity, Niswonger Children’s
Hospital coordinates the Kohl’s Kids on the Move
program, made possible through annual donations
from Kohl’s Cares©. Over the past six years, Kohl’s
Cares© has donated a total of $250,156 to support
the program. In 2012, Kohl’s Kids on the Move
provided nutrition education, jump ropes and jump
rope instruction to more than 8,000 children in
Northeast Tennessee and Southwest Virginia to help
reinforce the message of energy balance and the
importance of healthy lifestyle habits.
At Niswonger Children’s Hospital, we believe that
our commitment to children is more than trying to
make sick children well. Our goal is to help keep
children healthy through education and partnerships
with individuals and groups outside the walls of
the hospital.
Griffin Swinehart
Member, Kohl’s Kids
on the Move Club
NUMBER OF CHILDREN REACHED WITH
KOHL’S KIDS ON THE MOVE PROGRAM
7,195
8,500
8,967
8,184
9,560
–2008–
$29,352
–2009–
$43,231
–2010–
$45,124
–2011–
$56,327
–2012–
$55,059
33
94.8%
90.9%
92.4%
94.0%
100%
PEDIATRICS
PICU
NICU
CHILDREN’S ED
ST. JUDE*
e
g
A
t
n
e
i
Pat
Hand Hygiene
Compliance FY12
0
2
1
Y
F
n
o
i
istribut
D
1
2
3
4
6.14%
6.34%
7.92%
8.87%
15.66%
CAUTI INFECTIONS FY12
Catheter-Associated Urinary Tract Infection
(total number of infections)
PEDS, PICU & NICU
0
6
7
8
9
10
3.86%
4.28%
Methicillin-resistant
Staphylococcus Aureus
12
3.22%
*St. Jude Tri-Cities
Affiliate Clinic
3.22%
3.46%
MRSA
INFECTIONS FY12
0
11
3.68%
4.79%
PEDS & PICU
5
6.06%
13
3.71%
14
4.18%
15
4.11%
16
5.30%
17
5.82%
35
PEDIATRIC INPATIENT FY12
TENNESSEE
PEDIATRIC OUTPATIENT FY12
Carter
Cocke
Greene
Hamblen
Hancock
Hawkins
Johnson
Sullivan
Unicoi
Washington
272
9
131
4
3
83
104
379
91
781
VIRGINIA
47
39
32
5
35
63
29
78
57
97
126
4
Bristol
Buchanan
Dickenson
Grayson
Lee
Russell
Scott
Smyth
Tazewell
Washington
Wise
Wythe
NORTH CAROLINA
Avery
Mitchell
Watauga
Yancey
5
8
3
3
KENTUCKY
Harlan
Leslie
Letcher
38
1
8
OTHER
24
TOTAL
2,559
TOTAL IN & OUTPATIENT FY12
TENNESSEE
Carter
Cocke
Greene
Hamblen
Hancock
Hawkins
Johnson
Sullivan
Unicoi
Washington
3,074
90
908
34
9
556
552
3,803
1,554
16,226
VIRGINIA
Bristol
Buchanan
Dickenson
Grayson
Lee
Russell
Scott
Smyth
Tazewell
Washington
Wise
Wythe
152
131
79
11
106
193
161
159
163
429
444
17
NORTH CAROLINA
TENNESSEE
Carter
Cocke
Greene
Hamblen
Hancock
Hawkins
Johnson
Sullivan
Unicoi
Washington
3,346
99
1,039
38
12
639
656
4,182
1,645
17,007
VIRGINIA
199
170
111
16
141
256
190
237
220
526
570
21
Bristol
Buchanan
Dickenson
Grayson
Lee
Russell
Scott
Smyth
Tazewell
Washington
Wise
Wythe
4
19
5
68
7
16
NORTH CAROLINA
Harlan
Letcher
85
15
KENTUCKY
OTHER
337
TOTAL
29,407
Ashe
Avery
Madison
Mitchell
Watauga
Yancey
KENTUCKY
Ashe
Avery
Madison
Mitchell
Watauga
Yancey
5
24
5
76
10
19
Harlan
Leslie
Letcher
123
1
23
OTHER
361
TOTAL
31,967
HOSPITAL STATS
Inpatient Admissions
Inpatient Days
2,559
14,348
Average Length of Stay
4.57
Operational Beds
73
Observation Cases
935
Outpatients*
29,407
Children’s ED Visits
12,981
St. Jude Outpatient Treatments
2,420
Number of Surgeries
1,641
Children’s ED and St. Jude Tri-Cities Affiliante Clinic
patients included in total outpatients
*
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2
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o
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r
t
12011
10
> 0
6/2
013